Evaluation of the laryngoscopy view using the modified Cormack-Lehane scale during tracheal intubation in an intensive care unit. A prospective observational study | Revista Española de Anestesiología y Reanimación (English Edition)

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A prospective observational study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "250" "paginaFinal" => "258" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Taboada, R. Soto-Jove, P. Mirón, S. Martínez, R. Rey, E. Ferreiroa, X. Almeida, J. Álvarez, A. Baluja" "autores" => array:9 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Taboada" "email" => array:1 [ 0 => "manutabo@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Soto-Jove" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Mirón" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Martínez" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Rey" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Ferreiroa" ] 6 => array:2 [ "nombre" => "X." "apellidos" => "Almeida" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Álvarez" ] 8 => array:2 [ "nombre" => "A." "apellidos" => "Baluja" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la escala modificada de Cormack-Lehane para visión laringoscópica durante la intubación orotraqueal en una unidad de cuidados críticos. Estudio prospectivo observacional" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1009 "Ancho" => 1520 "Tamanyo" => 57658 ] ] "descripcion" => array:1 [ "en" => "Percentage of patients with mild, moderate and severe intubation difficulty according to the modified Cormack-Lehane (CL) scale. The difficulty in intubation increased in parallel with the modified CL grade (p<0.001)." ] ] ] "textoCompleto" => "IntroductionTracheal intubation (TI) is a procedure that is frequently used in the operating room and in critical care units (CCUs) to secure the airway. While the frequency of TI complications in the operating room is low, in the CCU this procedure has been associated with greater intubation difficulty and a greater number of complications, the most frequent being hypotension and hypoxia.<a class="elsevierStyleCrossRefs" href="#bib0185">1–7</a>Glottic view during TI is usually documented to describe the conditions and difficulty of the procedure. Although various scales can be used to describe glottic view during TI,<a class="elsevierStyleCrossRefs" href="#bib0220">8–11</a> the Cormack-Lehane (CL) scale is one of the most commonly used in both clinical practice and studies in airway management.<a class="elsevierStyleCrossRef" href="#bib0220">8</a> This scale was first described in 1984, and divides glottic view during laryngoscopy into 4 grades: (1) full view of glottis; (2) partial view of glottis; (3) only epiglottis seen; and (4) neither glottis nor epiglottis seen. Several authors have subsequently suggested modifications to this scale to include 5 grades and improve the description of glottic view.<a class="elsevierStyleCrossRefs" href="#bib0225">9,10</a> Yentis and Lee<a class="elsevierStyleCrossRef" href="#bib0225">9</a> divided the original grade 2 into 2a, partial view of the glottis, and 2b, only vision of the arytenoids, without modifying the remaining grades. This facilitates communication between clinicians who use the original scale and those that prefer Yentis and Lee's modified scale.<a class="elsevierStyleCrossRef" href="#bib0225">9</a> In our centre, we usually use the modified CL scale. Although use of these scales is widespread, few studies have validated their use, particularly in the CCU.The main objective of this prospective, observational study was to determine the correlation between the modified CL scale and intubation difficulty (number of TI attempts, intubation difficulty perceived by the anaesthesiologist, use of stylets) and the appearance of complications (hypotension, hypoxia, accidental oesophageal intubation) during TI in a CCU.Material and methodsOver a 45-month period (1 January 2015–30 September 2018), we prospectively evaluated all patients admitted to the CCU of the University Hospital of Santiago de Compostela. All patients of legal age, admitted to the unit for any type of medical or surgical care, who required intubation using direct laryngoscopy for any reason during their stay were included in the study. Patients under the age of 18, pregnant women, patients intubated outside the CCU or intubated using fibreoptic bronchoscopy or video laryngoscopy were excluded. The study was approved by the Galician Ethics Committee, and registered under number 2015/012. Given its observational, non-interventional design, informed consent was not necessary.All intubations were performed by anaesthesiologists attached to the Anaesthesia Service of the University Hospital of Santiago de Compostela (specialists with experience in difficult airway management, or residents under specialist supervision). Patients were prehydrated and preoxygenated prior to TI to extend hypotension and hypoxia times. Intubation was performed using a size 3 or 4 Macintosh blade, depending on the patient. The choice of induction agent and muscle relaxant was at the discretion of the attending anaesthesiologist. After an unsuccessful attempt, the patient was ventilated and a new TI attempt was made using direct laryngoscopy with some modification with respect to the first attempt (intubation aid, cricoid pressure, modification of the patient's position, change of anaesthesiologist, etc.). After intubation, the following data were collected: patient demographics (sex, age, weight, height, body mass index), reason for admission to the unit, who intubated the patient (resident or specialist), medications used for the intubation (hypnotic and muscle relaxant), reason for intubation, administration of non-invasive mechanical ventilation (NIMV) prior to intubation, degree of urgency for intubation, best glottic view according to the modified CL scale, number of intubation attempts, use of a stylet to facilitate intubation, the anaesthesiologist's perception of intubation difficulty (no difficulty, mild, moderate or severe difficulty), and complications during intubation (hypotension, hypoxia, accidental oesophageal TI).Glottal view was assessed using the modified CL scale<a class="elsevierStyleCrossRef" href="#bib0225">9</a>: (1) complete view of vocal cords (glottis); (2a) partial view of vocal cords (glottis); (2b) only posterior part of vocal cords or arytenoids seen; (3) only epiglottis seen, and (4) neither glottis nor epiglottis seen.Difficult intubation was defined as TI that required multiple attempts. An intubation attempt was defined as insertion of the laryngoscope into the trachea with an attempt to pass the tube through the vocal cords. Repositioning of only the laryngoscope blade was counted as a single attempt. Difficult laryngoscopy was defined as grades 2b, 3 and 4 on the modified CL scale. The degree of urgency of intubation was divided into: emergency (immediate), urgent (required in less than 30min) and semi-elective (can be delayed more than 30min). Intubation-related complications recorded were: accidental oesophageal intubation, hypotension (systolic blood pressure less than 80mmHg), severe hypotension (systolic blood pressure less than 65mmHg), hypoxia (oxygen saturation below 90%), severe hypoxia (oxygen saturation below 80%), during or within 30min of TI.The main objective of this prospective, observational study was to determine whether glottic view measured on the modified CL scale during TI with direct laryngoscopy in a CCU correlated with greater intubation difficulty (number of TI attempts, intubation difficulty perceived by the anaesthesiologist, use of stylets) and the appearance of complications (hypotension, hypoxia, accidental oesophageal intubation).Statistical analysisThis was an observational, prospective study. The sample size was calculated according to Cohen,<a class="elsevierStyleCrossRef" href="#bib0235">11</a> obtaining at least 350 patients for a Chi-square test of 4 degrees of freedom (Cormack grade vs. number of intubation attempts of 1 or more than 1), an alpha error of 1% and a power of 80%, to detect minor differences between the 2 groups (Cohen's w: 0.22).Numerical variables were tested for normality (Shapiro–Wilk test) and homoscedasticity (Levene test) and summarized using mean±standard deviation. Categorical variables were summarized by frequency and percentage of each category in respect of the total. The Wilcoxon test or the Pearson Chi-square test were used for the bivariate analysis. Multiple comparisons were penalized using the Benjamini and Hochberg's False Discovery Rate method<a class="elsevierStyleCrossRef" href="#bib0240">12</a> for an alpha error (q value) of 5%.All analyses were performed using R (R Core Team, Vienna, Austria), with the Bioconductor, Pwr, Qvalue, Ggplot2<a class="elsevierStyleCrossRef" href="#bib0245">13</a> and Dplyr<a class="elsevierStyleCrossRef" href="#bib0250">14</a> packages.ResultsDuring the study period, 8224 patients were admitted to the unit and 390 required TI. Thirty patients were excluded from the analysis for the following reasons: 20 patients underwent TI with video laryngoscope, 7 patients underwent TI with awake fibreoptic bronchoscopy, and 3 patients required urgent tracheotomy. A total of 360 patients who underwent TI with direct laryngoscopy were included in the study.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic characteristics of the patients included, the reason for admission to the unit, the reason for TI, and the drugs used for TI. The most common reason for TI was respiratory failure, and 53% of patients required NIMV before intubation. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows intubation difficulty according to the number of TI attempts, modified CL grade, the need for TI aids (Frova), as well as the difficulty perceived by the anaesthesiologist. Nearly all (89.7%) of the patients were intubated at the first attempt, and 20% required a Frova.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>After dividing patients into 5 groups according to glottic view, we did not find any differences between groups in respect of age, weight, height, body mass index, need for emergency or urgent TI, use of NIMV prior to TI, or intubation by a specialist or resident (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>; p=ns). We observed a direct correlation between difficult glottic view measured on the modified CL scale and intubation difficulty. The higher the modified CL grade, the lower the number of first-attempt TIs (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>; p<0.001) the higher the incidence of intubation with moderate or severe difficulty (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>; p<0.001) and the need for a Frova (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>; p<0.001). <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the incidence of no difficulty, mild, moderate and severe difficulty in each modified CL grade.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>Less than half (43%) of the patients presented some type of complication during TI (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). As the modified CL grade increased, so did the number of total complications, although this difference was not statistically significant (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>; p=0.16). <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> describes the incidence of hypotension, hypoxia and accidental oesophageal intubation. As the modified CL grade increased, we observed a significant increase in the incidence of hypoxia <90% (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>; p=0.00773) and hypoxia <80% (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>; p=0.00398); however, we found no correlation between the modified CL grade and hypotension <80mmHg (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> and <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>; p=0.16) or hypotension <65mmHg (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> and <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>; p=0.47).<elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>DiscussionIn this study, we have shown the close relationship between glottal view measured on the modified CL scale and greater difficulty during TI. The greater the modified CL grade during direct laryngoscopy, the lower the incidence of first-attempt intubation (1: 97%, 2a: 94%, 2b: 81%, 3: 60%, 4: 0%), increasing the difficulty in TI and the need for a stylet.Anaesthesiologists and other specialists involved in airway management are particularly interested in documenting and classifying glottic view during TI. Several scales, such as the CL,<a class="elsevierStyleCrossRef" href="#bib0220">8</a> the modified CL,<a class="elsevierStyleCrossRef" href="#bib0225">9</a> or the percentage of glottic opening score,<a class="elsevierStyleCrossRef" href="#bib0255">15</a> are frequently used when comparing different techniques or devices for difficult airway management. Although their use is widespread, few studies have attempted to validate them, particularly in the CCU. Although good glottic view during direct laryngoscopy does not always ensure easy TI, we have observed in this study that glottic view is associated with greater technical difficulty and a higher incidence of difficult intubation. Koh et al.<a class="elsevierStyleCrossRef" href="#bib0260">16</a> obtained similar results in a study performed in the operating room, noting that a higher CL grade was associated with a higher incidence of difficult TI (1: 0.7%, 2a: 13%, 2b: 65%, 3: 80%, 4: 100%). Although not the aim of their study, Soyuncu et al.,<a class="elsevierStyleCrossRef" href="#bib0265">17</a> in a study in which they intubated 366 patients in an emergency department, also observed that TI difficulty increased in parallel with the CL grade (1: 11%, 2: 25%, 3: 34%, 4: 82%).In our centre, the scale most frequently used to describe glottic view during TI is the modified CL.<a class="elsevierStyleCrossRef" href="#bib0225">9</a> In the original scale, “difficult laryngoscopy” is defined as the inability to visualize the vocal cords, and would only include grades 3 and 4. This means that the true incidence of “difficult laryngoscopy” may be underestimated, thereby excluding a subgroup of patients with difficult airway management that would otherwise be classified as grade 2. The modified CL scale includes a grade 2b within the definition of “difficult laryngoscopy”. In this study, grade 2b was associated with moderate or severe difficulty in a greater percentage of patients (36% vs. 4%) and greater use of Frova devices (45% vs. 8%) vs. grade 2a. Koh et al.<a class="elsevierStyleCrossRef" href="#bib0260">16</a> also observed that grade 2b was associated with a higher incidence of difficult intubation compared to grade 2a (65% vs. 13%), and recommended the modified CL scale over the original version, because they considered that it better described the difficulty of laryngoscopic vision.Many authors consider the CCU to be a risk factor for difficult TI and complications. The risk of difficult TI ranges from 8% to 12%,<a class="elsevierStyleCrossRefs" href="#bib0185">1–7</a> far higher than the 1–4% encountered in the operating room.<a class="elsevierStyleCrossRefs" href="#bib0185">1,2</a> In a recent study, Taboada et al.<a class="elsevierStyleCrossRef" href="#bib0185">1</a> compared TI conditions and TI-related complications while intubating the same patient in the operating room and later in the CCU. They showed that, although the procedure was performed on the same patient, the intubation performed in the CCU was associated with worse glottic view and a higher modified CL grade, which led to a lower incidence of first-attempt intubation, an increase in technical TI difficulties, and a greater number of complications. The authors concluded that poor glottic view during direct laryngoscopy could be responsible for the greater intubation difficulties encountered in the CCU compared to the operating room.Poorer glottic view during TI in the CCU may be due to factors related to the operator, the environment, or the patient.<a class="elsevierStyleCrossRef" href="#bib0270">18</a> Operator-related factors include the level of experience and training,<a class="elsevierStyleCrossRefs" href="#bib0200">4,19</a> the level of supervision among residents,<a class="elsevierStyleCrossRef" href="#bib0280">20</a> the possible involvement of 2 operators in the TI,<a class="elsevierStyleCrossRef" href="#bib0195">3</a> and the use of muscle relaxants.<a class="elsevierStyleCrossRefs" href="#bib0285">21–24</a> Environmental factors would include the UCC itself. Many authors have described the CCU as a risk factor for difficult TI. While TI in the operating room is usually performed in a stable patient and in a suitable, quiet room with adequate lighting, TI in the CCU is often performed in an environment that is suboptimal for airway management, with poor lighting, scant material, limited space, and awkward access to the patient's bed to perform intubation. Patient-related factors would involve anatomical and physiological characteristics. Patients requiring TI in a CCU often have a full stomach and present hypoxaemia, some degree of pulmonary dysfunction, haemodynamic instability, and oedema, and TI is often performed urgently, with little time to evaluate and plan the procedure. For all these reasons, Mosier et al.<a class="elsevierStyleCrossRef" href="#bib0305">25</a> suggest that every patient admitted to a CCU should be considered as having a “physiologically difficult airway”. All these factors could be responsible for poor glottic view during direct laryngoscopy, accentuating the difficulty of TI.TI in the CCU has been associated with a number of complications, the most frequent being hypotension and hypoxia.<a class="elsevierStyleCrossRefs" href="#bib0185">1–7</a> The risk of these complications is multifactorial, and includes factors related to the patient, the experience of the clinician performing the technique, pharmacological management, pre-intubation conditions,<a class="elsevierStyleCrossRefs" href="#bib0195">3,6,26,27</a> and the number of attempts required for successful TI.<a class="elsevierStyleCrossRefs" href="#bib0320">28,29</a> Sakles et al.<a class="elsevierStyleCrossRef" href="#bib0325">29</a> observed that the number of complications increased from 14% to 47% when a second TI attempt was needed. Simpson et al.,<a class="elsevierStyleCrossRef" href="#bib0210">6</a> in a multicentre study, showed that the frequency of severe hypoxia increased up to 14 fold in patients who required more than 2 attempts at TI. In our study, 43% of the patients presented some type of complication during TI, and we observed that the incidence of hypoxia increased in parallel with the modified CL grade; however, the incidence of hypotension remained stable regardless of the modified CL grade. In critically ill patients, hypotension that occurs during or a few minutes after TI is one of the most frequent complications, with an incidence of between 20% and 40%.<a class="elsevierStyleCrossRefs" href="#bib0185">1–7</a> The high incidence of hypotension in critical patients may be due to their hypovolaemic state, anaesthetic-induced inhibition of the sympathetic response, or positive intrathoracic pressure due to mechanical ventilation. In our study, we observed that this complication was independent of glottic view and the difficulty encountered during TI. However, we observed a close relationship between a higher modified CL grade and an increase in the incidence of hypoxia. One explanation for this could be that a high modified CL grade leads to greater difficulty in glottic view, greater technical difficulty in performing TI, and a greater number of TI attempts. This, coupled with the fact that the most frequent reason for TI in our patients was respiratory failure (77%), and that 53% of them needed NIMV prior to TI, could explain why the incidence of hypoxia increase in parallel with an increase in the modified CL grade. Arulkumaran et al.,<a class="elsevierStyleCrossRef" href="#bib0330">30</a> in a recent retrospective study evaluating 881 TIs, also found a greater number of complications in patients with a high CL grade (6.6% in grade 1, 10.8% in grade 2, 32% in grade 3). However, these authors did not define hypotension or hypoxia, and did not analyze these complications separately. Martin et al.<a class="elsevierStyleCrossRef" href="#bib0275">19</a> showed that CL grades 3 and 4 were independent predictors of complications during emergency intubations, but they also did not analyze these complications separately.Many authors are concerned about the high incidence of difficult intubation and complications during TI in CCUs. It is very important to identify patients that are likely to present a difficult airway by using scales such as MACOCHA,<a class="elsevierStyleCrossRef" href="#bib0335">31</a> promoting the use of pre-intubation checklists,<a class="elsevierStyleCrossRef" href="#bib0270">18</a> or drawing up TI guidelines.<a class="elsevierStyleCrossRef" href="#bib0340">32</a> Several studies have attempted to determine whether the use of video laryngoscopes in CCUs could improve glottic view, thus optimizing intubation conditions and decreasing the associated complications.<a class="elsevierStyleCrossRefs" href="#bib0345">33–36</a> The role of these devices in the CCU has yet to be fully clarified, and their routine use is not currently recommended.<a class="elsevierStyleCrossRefs" href="#bib0355">35,36</a> According to recent guidelines on intubation in intensive care<a class="elsevierStyleCrossRef" href="#bib0340">32</a> video laryngoscopes should be available during TI in CCUs, and should be an option during intubation.Our study has several limitations. First, it was performed in the CCU of the University Hospital of Santiago de Compostela. Caution should be observed when extrapolating the results obtained in a single centre to other centres with different working protocols. A similar multicentre study could validate these results. Secondly, all TIs were performed by either anaesthesiologists or residents with at least 2 years of experience in anaesthesia, always supervised by specialist. Our results might have differed if TIs were not performed by anaesthesiologists or were performed by clinicians with no experience in difficult airway management. Third, this was an observational study. Both complications and variables related to intubation difficulty were recorded by anaesthesiologists, and we cannot completely rule out the possibility of data collection errors. Fourth, the only complications collected were hypotension, hypoxia and accidental oesophageal intubation. The collection of a greater number of complications could have improved the quality of the study. Despite these limitations, we believe that this study contributes important information on airway management in the CCU.ConclusionsIn this study, we have shown that the modified CL scale is effective in determining the difficulty of direct laryngoscopy during TI and the risk of difficult intubation. We show that the greater the modified CL grade, the greater the difficulty in performing TI. The incidence of hypoxia correlated directly with a greater modified CL grade, but we found no correlation between hypotension and the modified CL scale.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1188403" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1108253" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1188404" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1108252" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack405901" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-11-08" "fechaAceptado" => "2019-01-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1108253" "palabras" => array:6 [ 0 => "Orotracheal intubation" 1 => "Critical care" 2 => "Intensive care unit" 3 => "Complications" 4 => "Hypotension" 5 => "Hypoxia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1108252" "palabras" => array:6 [ 0 => "Intubación orotraqueal" 1 => "Cuidados críticos" 2 => "Unidad de Cuidados Intensivos" 3 => "Complicaciones" 4 => "Hipotensión" 5 => "Hipoxia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectivesTracheal intubation in the intensive care unit is associated with a high incidence of difficult intubation and complications. This may be due to a poor view of the glottis during direct laryngoscopy. The aim of this study is to determine if there is a relationship between laryngoscopy view using the modified Cormack-Lehane scale with the incidence of difficult intubation and complications. MethodsAll patients who were subjected to tracheal intubated with direct laryngoscopy in the intensive care unit over a 45-month period were included in the study. In all patients, an evaluation was made of the laryngoscopy view using the modified Cormack-Lehane scale, as well as the technical difficulty (number of intubations at first attempt, operator-reported difficulty, need for a Frova introducer), and the incidence of complications (hypotension, hypoxia, oesophageal intubation). ResultsA total of 360 patients were included. When the grade of the modified Cormack-Lehane scale was increased from 1 to 4, the incidence of first success rate intubation decreased (1: 97%, 2a: 94%, 2b: 80%, 3: 60%, 4: 0%, p<.001), the incidence of moderate and severe difficulty intubation increased (1: 2%, 2a: 4%, 2b: 36%, 3: 77%, 4: 100%, p<.001.), as well as the need for a Frova guide (1: 7%, 2a: 8%, 2b: 45%, 3: 60%, 4: 100%, p<.001). When the grade of the modified Cormack-Lehane scale increased from 1 to 4, the incidence of hypoxia <90% increased (1: 20%, 2a: 20%, 2b: 28%, 3: 47%, 4: 100%, p=.0073), as well as hypoxia <80% (1: 11%, 2a: 10%, 2b: 12%, 3: 27%, 4: 100%, p=.00398). No relationship was observed between the incidence of hypotension and the grade of the modified Cormack-Lehane scale (p=ns). ConclusionsDuring tracheal intubation in the intensive care unit a close relationship was found between a poor laryngoscopy view using the modified Cormack-Lehane scale and a higher difficulty technique of intubation. A relationship was found between the incidence of hypoxia with a higher grade in the modified Cormack-Lehane scale. No relationship was found between hypotension and the modified Cormack-Lehane scale." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivosLa intubación orotraqueal en las unidades de cuidados críticos está asociada a una frecuencia alta de dificultad y complicaciones. Una mala visión glótica durante la laringoscopia directa podría ser la causa. El objetivo de este estudio es evaluar si existe una relación entre la visión laringoscópica valorada por la escala modificada de Cormack-Lehane y la dificultad de intubación y la aparición de complicaciones. MétodosSe incluyeron todos los pacientes intubados con laringoscopia directa en la Unidad de Cuidados Críticos durante un periodo de 45 meses. En todos los pacientes se valoró la visión glótica medida con la escala modificada de Cormack-Lehane, la dificultad de intubación (intubación al primer intento, dificultad valorada por el anestesiólogo, uso de la guía de Frova) y la aparición de complicaciones (hipotensión, hipoxia, intubación esofágica). ResultadosSe incluyeron 360 pacientes. A medida que aumentó el grado en la escala modificada de Cormack-Lehane, disminuyó la incidencia de intubación orotraqueal al primer intento (1: 97%, 2a: 94%, 2b: 80%, 3: 60%, 4: 0%, p<0,001), aumentó la incidencia de intubación con dificultad moderada o severa (1: 2%, 2a: 4%, 2b: 36%, 3: 77%, 4: 100%, p<0,001), así como la necesidad de uso de Frova (1: 7%, 2a: 8%, 2b: 45%, 3: 60%, 4: 100%, p<0,001). A medida que aumentó el grado en la escala modificada de Cormack-Lehane, aumentó la aparición de hipoxia <90% (1: 20%, 2a: 20%, 2b: 28%, 3: 47%, 4: 100%, p=0,0073) y la hipoxia <80% (1: 11%, 2a: 10%, 2b: 12%, 3: 27%, 4: 100%, p=0,00398). No encontramos relación entre la aparición de hipotensión y el grado en la escala modificada de Cormack-Lehane (p=ns). ConclusionesDurante la intubación orotraqueal en la Unidad de Cuidados Críticos hemos encontrado una estrecha relación entre una mala visión glótica valorada por la escala modificada de Cormack-Lehane y una mayor dificultad de la técnica. La incidencia de hipoxia se relaciona directamente con un mayor grado en la escala modificada de Cormack-Lehane. No hemos encontrado ninguna relación entre la hipotensión y la escala modificada de Cormack-Lehane." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Taboada M, Soto-Jove R, Mirón P, Martínez S, Rey R, Ferreiroa E, et al. Evaluación de la escala modificada de Cormack-Lehane para visión laringoscópica durante la intubación orotraqueal en una unidad de cuidados críticos. Estudio prospectivo observacional. Rev Esp Anestesiol Reanim. 2019;66:250–258." ] ] "multimedia" => array:10 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1009 "Ancho" => 1520 "Tamanyo" => 57658 ] ] "descripcion" => array:1 [ "en" => "Percentage of patients with mild, moderate and severe intubation difficulty according to the modified Cormack-Lehane (CL) scale. The difficulty in intubation increased in parallel with the modified CL grade (p<0.001)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1009 "Ancho" => 1507 "Tamanyo" => 53017 ] ] "descripcion" => array:1 [ "en" => "Percentage of patients presenting some type of complication (hypotension, hypoxia or accidental oesophageal intubation) during tracheal intubation (TI) according to the modified Cormack-Lehane (CL) scale. There was a trend towards an increase in the number of complications during TI as the modified CL grade increases, but this was not statistically significant (p=0.16)." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1005 "Ancho" => 1506 "Tamanyo" => 51737 ] ] "descripcion" => array:1 [ "en" => "Percentage of patients with StO2≥90%, StO2<90% or ≥80%, StO2<80% during tracheal intubation (TI), according to the modified Cormack-Lehane (CL) scale. TI correlated with a greater incidence of hypoxia StO2<90% (p=0.00773) and hypoxia SpO2<80% (p=0.00398) as the CL grade increased." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1070 "Ancho" => 1514 "Tamanyo" => 56565 ] ] "descripcion" => array:1 [ "en" => "Percentage of patients with systolic arterial pressure (SAP)≥80mmHg, SAP<80mmHg or ≥L65mmHg, SAP<65mmHg during intubation (TI), according to the modified Cormack-Lehane (CL) scale. The modified CL scale did not correlate with hypotension<80mmHg (p=0.16) or hypotension<65mmHg (p=047)." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BMI: body mass index; NIMV: non-invasive mechanical ventilation; SD: standard deviation.Data shown as number of patients (%) or mean±standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total patients (n=360) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Demographics</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69±12.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">106 (30.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75±15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">165±8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27±5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI≥30kg/m2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97 (26.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Reason for admission to the CCU</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">117 (32.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">105 (29.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemodynamic instability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 (13) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurological instability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 (10.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 (17.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Indication for tracheal intubation</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">277 (76.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemodynamic instability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 (17.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurological instability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 (20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Self extubación \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extubation failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (6.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Scheduled \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Use of NIMV prior to intubation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">191 (53) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Type of intubation</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Semielective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">112 (31.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">223 (61.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urgent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (6.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Medications used for tracheal intubation</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypnotics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">353 (98) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Propofol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">275 (77.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Etomidate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 (20.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Midazolam \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Muscle relaxants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">350 (97.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Succinylcholine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">310 (88.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rocuronium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (9.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cisatracurium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2027854.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient demographics and aspects related to patients intubated during the study period." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients (N=360) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Number of intubation attempts</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">One attempt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">323 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Two attempts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Three attempts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Intubation difficulty perceived by the anaesthesiologist</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No difficulty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">206 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Slightly difficult \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderately difficult \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extremely difficult \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Modified Cormack-Lehane scale</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade 2b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Use of Frova for intubation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2027850.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of intubation difficulty in the Critical Care Unit during the study period." ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BMI: body mass index; NIMV: non-invasive mechanical ventilation; TI: tracheal intubation.Data shown as number (percentage) or mean±standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-1 200 (55) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2a 50 (13.9) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2b 78 (21.7) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-3 30 (8.3) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-4 2 (0.6) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68±13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69±14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74±15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75±12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77±13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79±19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84±30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">165±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">165±7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">165±8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">165±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">159±14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.92 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m<a class="elsevierStyleCrossRef" href="#bib0190">2</a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29±7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI>30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency or urgent TI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">142 (71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 (57.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (83.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Use of NIMV prior to intubation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (46) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 (52.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (63.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intubated by: specialist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2027852.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic and intubation data in the 5 laryngoscopic view grades in the modified Cormack-Lehane scale." ] ] 7 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data shown as number (percentage)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-1 200 (55) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2a 50 (13.9) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2b 78 (21.7) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-3 30 (8.3) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-4 2 (0.6) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of intubation attempts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">One attempt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">195 (97.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 (94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63 (79.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Two attempts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (19.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (26.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Three attempts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (13.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intubation difficulty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No difficulty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">164 (82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (7.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Slightly difficult \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 (56.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderately difficult \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 (34.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extremely difficult \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Use of Frova for intubation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (44.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (56.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2027851.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Correlation between number of intubation attempts, intubation difficulty perceived by the anaesthesiologist, and use of a Frova and the modified Cormack-Lehane scale determined during direct laryngoscopy." ] ] 8 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data shown as number (percentage)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N. patients 360 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">155 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild hypotension (<80mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">108 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe hypotension (<65mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild hypoxia (<90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe hypoxia (<80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Accidental oesophageal intubation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2027849.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Complications during tracheal intubation in the CCU during the study period." ] ] 9 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Data shown as number (percentage)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-1 200 (55) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2a 50 (13.9) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2b 78 (21.7) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-3 30 (8.3) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-4 2 (0.6) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76 (38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild hypotension (<80mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51 (25.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (34.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (36.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe hypotension (<65mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (20.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.47 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild hypoxia (<90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 (20.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (46.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00773 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe hypoxia (<80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (26.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00398 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Accidental oesophageal intubation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (13.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (50) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2027853.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Correlation between complications during tracheal intubation and the modified Cormack-Lehane scale determined during direct laryngoscopy." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0185" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of tracheal intubation conditions in operating room and intensive care unit: a prospective, observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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Evaluation of the laryngoscopy view using the modified Cormack-Lehane scale during tracheal intubation in an intensive care unit. A prospective observational study

Evaluación de la escala modificada de Cormack-Lehane para visión laringoscópica durante la intubación orotraqueal en una unidad de cuidados críticos. Estudio prospectivo observacional

M. Taboada

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manutabo@yahoo.es

Corresponding author.

, R. Soto-Jove, P. Mirón, S. Martínez, R. Rey, E. Ferreiroa, X. Almeida, J. Álvarez, A. Baluja

Grupo de Investigación Enfermo Crítico, Unidad de Cuidados Críticos, Servicio de Anestesiología, Hospital Clínico Universitario de Santiago de Compostela, Fundación Instituto de Investigación Sanitaria, Santiago de Compostela, A Coruña, Spain

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    "titulo" => "Evaluation of the laryngoscopy view using the modified Cormack-Lehane scale during tracheal intubation in an intensive care unit&#46; A prospective observational study"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Percentage of patients with mild&#44; moderate and severe intubation difficulty according to the modified Cormack-Lehane &#40;CL&#41; scale&#46; The difficulty in intubation increased in parallel with the modified CL grade &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tracheal intubation &#40;TI&#41; is a procedure that is frequently used in the operating room and in critical care units &#40;CCUs&#41; to secure the airway&#46; While the frequency of TI complications in the operating room is low&#44; in the CCU this procedure has been associated with greater intubation difficulty and a greater number of complications&#44; the most frequent being hypotension and hypoxia&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#8211;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Glottic view during TI is usually documented to describe the conditions and difficulty of the procedure&#46; Although various scales can be used to describe glottic view during TI&#44;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#8211;11</span></a> the Cormack-Lehane &#40;CL&#41; scale is one of the most commonly used in both clinical practice and studies in airway management&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a> This scale was first described in 1984&#44; and divides glottic view during laryngoscopy into 4 grades&#58; &#40;1&#41; full view of glottis&#59; &#40;2&#41; partial view of glottis&#59; &#40;3&#41; only epiglottis seen&#59; and &#40;4&#41; neither glottis nor epiglottis seen&#46; Several authors have subsequently suggested modifications to this scale to include 5 grades and improve the description of glottic view&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">9&#44;10</span></a> Yentis and Lee<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> divided the original grade 2 into 2a&#44; partial view of the glottis&#44; and 2b&#44; only vision of the arytenoids&#44; without modifying the remaining grades&#46; This facilitates communication between clinicians who use the original scale and those that prefer Yentis and Lee&#39;s modified scale&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> In our centre&#44; we usually use the modified CL scale&#46; Although use of these scales is widespread&#44; few studies have validated their use&#44; particularly in the CCU&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The main objective of this prospective&#44; observational study was to determine the correlation between the modified CL scale and intubation difficulty &#40;number of TI attempts&#44; intubation difficulty perceived by the anaesthesiologist&#44; use of stylets&#41; and the appearance of complications &#40;hypotension&#44; hypoxia&#44; accidental oesophageal intubation&#41; during TI in a CCU&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Over a 45-month period &#40;1 January 2015&#8211;30 September 2018&#41;&#44; we prospectively evaluated all patients admitted to the CCU of the University Hospital of Santiago de Compostela&#46; All patients of legal age&#44; admitted to the unit for any type of medical or surgical care&#44; who required intubation using direct laryngoscopy for any reason during their stay were included in the study&#46; Patients under the age of 18&#44; pregnant women&#44; patients intubated outside the CCU or intubated using fibreoptic bronchoscopy or video laryngoscopy were excluded&#46; The study was approved by the Galician Ethics Committee&#44; and registered under number 2015&#47;012&#46; Given its observational&#44; non-interventional design&#44; informed consent was not necessary&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">All intubations were performed by anaesthesiologists attached to the Anaesthesia Service of the University Hospital of Santiago de Compostela &#40;specialists with experience in difficult airway management&#44; or residents under specialist supervision&#41;&#46; Patients were prehydrated and preoxygenated prior to TI to extend hypotension and hypoxia times&#46; Intubation was performed using a size 3 or 4 Macintosh blade&#44; depending on the patient&#46; The choice of induction agent and muscle relaxant was at the discretion of the attending anaesthesiologist&#46; After an unsuccessful attempt&#44; the patient was ventilated and a new TI attempt was made using direct laryngoscopy with some modification with respect to the first attempt &#40;intubation aid&#44; cricoid pressure&#44; modification of the patient&#39;s position&#44; change of anaesthesiologist&#44; etc&#46;&#41;&#46; After intubation&#44; the following data were collected&#58; patient demographics &#40;sex&#44; age&#44; weight&#44; height&#44; body mass index&#41;&#44; reason for admission to the unit&#44; who intubated the patient &#40;resident or specialist&#41;&#44; medications used for the intubation &#40;hypnotic and muscle relaxant&#41;&#44; reason for intubation&#44; administration of non-invasive mechanical ventilation &#40;NIMV&#41; prior to intubation&#44; degree of urgency for intubation&#44; best glottic view according to the modified CL scale&#44; number of intubation attempts&#44; use of a stylet to facilitate intubation&#44; the anaesthesiologist&#39;s perception of intubation difficulty &#40;no difficulty&#44; mild&#44; moderate or severe difficulty&#41;&#44; and complications during intubation &#40;hypotension&#44; hypoxia&#44; accidental oesophageal TI&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Glottal view was assessed using the modified CL scale<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a>&#58; &#40;1&#41; complete view of vocal cords &#40;glottis&#41;&#59; &#40;2a&#41; partial view of vocal cords &#40;glottis&#41;&#59; &#40;2b&#41; only posterior part of vocal cords or arytenoids seen&#59; &#40;3&#41; only epiglottis seen&#44; and &#40;4&#41; neither glottis nor epiglottis seen&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Difficult intubation was defined as TI that required multiple attempts&#46; An intubation attempt was defined as insertion of the laryngoscope into the trachea with an attempt to pass the tube through the vocal cords&#46; Repositioning of only the laryngoscope blade was counted as a single attempt&#46; Difficult laryngoscopy was defined as grades 2b&#44; 3 and 4 on the modified CL scale&#46; The degree of urgency of intubation was divided into&#58; emergency &#40;immediate&#41;&#44; urgent &#40;required in less than 30<span class="elsevierStyleHsp" style=""></span>min&#41; and semi-elective &#40;can be delayed more than 30<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; Intubation-related complications recorded were&#58; accidental oesophageal intubation&#44; hypotension &#40;systolic blood pressure less than 80<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#44; severe hypotension &#40;systolic blood pressure less than 65<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#44; hypoxia &#40;oxygen saturation below 90&#37;&#41;&#44; severe hypoxia &#40;oxygen saturation below 80&#37;&#41;&#44; during or within 30<span class="elsevierStyleHsp" style=""></span>min of TI&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The main objective of this prospective&#44; observational study was to determine whether glottic view measured on the modified CL scale during TI with direct laryngoscopy in a CCU correlated with greater intubation difficulty &#40;number of TI attempts&#44; intubation difficulty perceived by the anaesthesiologist&#44; use of stylets&#41; and the appearance of complications &#40;hypotension&#44; hypoxia&#44; accidental oesophageal intubation&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">This was an observational&#44; prospective study&#46; The sample size was calculated according to Cohen&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a> obtaining at least 350 patients for a Chi-square test of 4 degrees of freedom &#40;Cormack grade vs&#46; number of intubation attempts of 1 or more than 1&#41;&#44; an alpha error of 1&#37; and a power of 80&#37;&#44; to detect minor differences between the 2 groups &#40;Cohen&#39;s w&#58; 0&#46;22&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Numerical variables were tested for normality &#40;Shapiro&#8211;Wilk test&#41; and homoscedasticity &#40;Levene test&#41; and summarized using mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46; Categorical variables were summarized by frequency and percentage of each category in respect of the total&#46; The Wilcoxon test or the Pearson Chi-square test were used for the bivariate analysis&#46; Multiple comparisons were penalized using the Benjamini and Hochberg&#39;s False Discovery Rate method<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> for an alpha error &#40;<span class="elsevierStyleItalic">q</span> value&#41; of 5&#37;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">All analyses were performed using R &#40;R Core Team&#44; Vienna&#44; Austria&#41;&#44; with the Bioconductor&#44; Pwr&#44; Qvalue&#44; Ggplot2<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a> and Dplyr<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a> packages&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">During the study period&#44; 8224 patients were admitted to the unit and 390 required TI&#46; Thirty patients were excluded from the analysis for the following reasons&#58; 20 patients underwent TI with video laryngoscope&#44; 7 patients underwent TI with awake fibreoptic bronchoscopy&#44; and 3 patients required urgent tracheotomy&#46; A total of 360 patients who underwent TI with direct laryngoscopy were included in the study&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic characteristics of the patients included&#44; the reason for admission to the unit&#44; the reason for TI&#44; and the drugs used for TI&#46; The most common reason for TI was respiratory failure&#44; and 53&#37; of patients required NIMV before intubation&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows intubation difficulty according to the number of TI attempts&#44; modified CL grade&#44; the need for TI aids &#40;Frova&#41;&#44; as well as the difficulty perceived by the anaesthesiologist&#46; Nearly all &#40;89&#46;7&#37;&#41; of the patients were intubated at the first attempt&#44; and 20&#37; required a Frova&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">After dividing patients into 5 groups according to glottic view&#44; we did not find any differences between groups in respect of age&#44; weight&#44; height&#44; body mass index&#44; need for emergency or urgent TI&#44; use of NIMV prior to TI&#44; or intubation by a specialist or resident &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>ns&#41;&#46; We observed a direct correlation between difficult glottic view measured on the modified CL scale and intubation difficulty&#46; The higher the modified CL grade&#44; the lower the number of first-attempt TIs &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; the higher the incidence of intubation with moderate or severe difficulty &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and the need for a Frova &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the incidence of no difficulty&#44; mild&#44; moderate and severe difficulty in each modified CL grade&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Less than half &#40;43&#37;&#41; of the patients presented some type of complication during TI &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; As the modified CL grade increased&#44; so did the number of total complications&#44; although this difference was not statistically significant &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;16&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> describes the incidence of hypotension&#44; hypoxia and accidental oesophageal intubation&#46; As the modified CL grade increased&#44; we observed a significant increase in the incidence of hypoxia <span class="elsevierStyleMonospace">&#60;</span>90&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;00773&#41; and hypoxia <span class="elsevierStyleMonospace">&#60;</span>80&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;00398&#41;&#59; however&#44; we found no correlation between the modified CL grade and hypotension <span class="elsevierStyleMonospace">&#60;</span>80<span class="elsevierStyleHsp" style=""></span>mmHg &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> and <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;16&#41; or hypotension <span class="elsevierStyleMonospace">&#60;</span>65<span class="elsevierStyleHsp" style=""></span>mmHg &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> and <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;47&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In this study&#44; we have shown the close relationship between glottal view measured on the modified CL scale and greater difficulty during TI&#46; The greater the modified CL grade during direct laryngoscopy&#44; the lower the incidence of first-attempt intubation &#40;1&#58; 97&#37;&#44; 2a&#58; 94&#37;&#44; 2b&#58; 81&#37;&#44; 3&#58; 60&#37;&#44; 4&#58; 0&#37;&#41;&#44; increasing the difficulty in TI and the need for a stylet&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Anaesthesiologists and other specialists involved in airway management are particularly interested in documenting and classifying glottic view during TI&#46; Several scales&#44; such as the CL&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a> the modified CL&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> or the percentage of glottic opening score&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a> are frequently used when comparing different techniques or devices for difficult airway management&#46; Although their use is widespread&#44; few studies have attempted to validate them&#44; particularly in the CCU&#46; Although good glottic view during direct laryngoscopy does not always ensure easy TI&#44; we have observed in this study that glottic view is associated with greater technical difficulty and a higher incidence of difficult intubation&#46; Koh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> obtained similar results in a study performed in the operating room&#44; noting that a higher CL grade was associated with a higher incidence of difficult TI &#40;1&#58; 0&#46;7&#37;&#44; 2a&#58; 13&#37;&#44; 2b&#58; 65&#37;&#44; 3&#58; 80&#37;&#44; 4&#58; 100&#37;&#41;&#46; Although not the aim of their study&#44; Soyuncu et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a> in a study in which they intubated 366 patients in an emergency department&#44; also observed that TI difficulty increased in parallel with the CL grade &#40;1&#58; 11&#37;&#44; 2&#58; 25&#37;&#44; 3&#58; 34&#37;&#44; 4&#58; 82&#37;&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In our centre&#44; the scale most frequently used to describe glottic view during TI is the modified CL&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> In the original scale&#44; &#8220;difficult laryngoscopy&#8221; is defined as the inability to visualize the vocal cords&#44; and would only include grades 3 and 4&#46; This means that the true incidence of &#8220;difficult laryngoscopy&#8221; may be underestimated&#44; thereby excluding a subgroup of patients with difficult airway management that would otherwise be classified as grade 2&#46; The modified CL scale includes a grade 2b within the definition of &#8220;difficult laryngoscopy&#8221;&#46; In this study&#44; grade 2b was associated with moderate or severe difficulty in a greater percentage of patients &#40;36&#37; vs&#46; 4&#37;&#41; and greater use of Frova devices &#40;45&#37; vs&#46; 8&#37;&#41; vs&#46; grade 2a&#46; Koh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> also observed that grade 2b was associated with a higher incidence of difficult intubation compared to grade 2a &#40;65&#37; vs&#46; 13&#37;&#41;&#44; and recommended the modified CL scale over the original version&#44; because they considered that it better described the difficulty of laryngoscopic vision&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Many authors consider the CCU to be a risk factor for difficult TI and complications&#46; The risk of difficult TI ranges from 8&#37; to 12&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#8211;7</span></a> far higher than the 1&#8211;4&#37; encountered in the operating room&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;2</span></a> In a recent study&#44; Taboada et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">1</span></a> compared TI conditions and TI-related complications while intubating the same patient in the operating room and later in the CCU&#46; They showed that&#44; although the procedure was performed on the same patient&#44; the intubation performed in the CCU was associated with worse glottic view and a higher modified CL grade&#44; which led to a lower incidence of first-attempt intubation&#44; an increase in technical TI difficulties&#44; and a greater number of complications&#46; The authors concluded that poor glottic view during direct laryngoscopy could be responsible for the greater intubation difficulties encountered in the CCU compared to the operating room&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Poorer glottic view during TI in the CCU may be due to factors related to the operator&#44; the environment&#44; or the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> Operator-related factors include the level of experience and training&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;19</span></a> the level of supervision among residents&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a> the possible involvement of 2 operators in the TI&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">3</span></a> and the use of muscle relaxants&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">21&#8211;24</span></a> Environmental factors would include the UCC itself&#46; Many authors have described the CCU as a risk factor for difficult TI&#46; While TI in the operating room is usually performed in a stable patient and in a suitable&#44; quiet room with adequate lighting&#44; TI in the CCU is often performed in an environment that is suboptimal for airway management&#44; with poor lighting&#44; scant material&#44; limited space&#44; and awkward access to the patient&#39;s bed to perform intubation&#46; Patient-related factors would involve anatomical and physiological characteristics&#46; Patients requiring TI in a CCU often have a full stomach and present hypoxaemia&#44; some degree of pulmonary dysfunction&#44; haemodynamic instability&#44; and oedema&#44; and TI is often performed urgently&#44; with little time to evaluate and plan the procedure&#46; For all these reasons&#44; Mosier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">25</span></a> suggest that every patient admitted to a CCU should be considered as having a &#8220;physiologically difficult airway&#8221;&#46; All these factors could be responsible for poor glottic view during direct laryngoscopy&#44; accentuating the difficulty of TI&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">TI in the CCU has been associated with a number of complications&#44; the most frequent being hypotension and hypoxia&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#8211;7</span></a> The risk of these complications is multifactorial&#44; and includes factors related to the patient&#44; the experience of the clinician performing the technique&#44; pharmacological management&#44; pre-intubation conditions&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">3&#44;6&#44;26&#44;27</span></a> and the number of attempts required for successful TI&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">28&#44;29</span></a> Sakles et al&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a> observed that the number of complications increased from 14&#37; to 47&#37; when a second TI attempt was needed&#46; Simpson et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> in a multicentre study&#44; showed that the frequency of severe hypoxia increased up to 14 fold in patients who required more than 2 attempts at TI&#46; In our study&#44; 43&#37; of the patients presented some type of complication during TI&#44; and we observed that the incidence of hypoxia increased in parallel with the modified CL grade&#59; however&#44; the incidence of hypotension remained stable regardless of the modified CL grade&#46; In critically ill patients&#44; hypotension that occurs during or a few minutes after TI is one of the most frequent complications&#44; with an incidence of between 20&#37; and 40&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#8211;7</span></a> The high incidence of hypotension in critical patients may be due to their hypovolaemic state&#44; anaesthetic-induced inhibition of the sympathetic response&#44; or positive intrathoracic pressure due to mechanical ventilation&#46; In our study&#44; we observed that this complication was independent of glottic view and the difficulty encountered during TI&#46; However&#44; we observed a close relationship between a higher modified CL grade and an increase in the incidence of hypoxia&#46; One explanation for this could be that a high modified CL grade leads to greater difficulty in glottic view&#44; greater technical difficulty in performing TI&#44; and a greater number of TI attempts&#46; This&#44; coupled with the fact that the most frequent reason for TI in our patients was respiratory failure &#40;77&#37;&#41;&#44; and that 53&#37; of them needed NIMV prior to TI&#44; could explain why the incidence of hypoxia increase in parallel with an increase in the modified CL grade&#46; Arulkumaran et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> in a recent retrospective study evaluating 881 TIs&#44; also found a greater number of complications in patients with a high CL grade &#40;6&#46;6&#37; in grade 1&#44; 10&#46;8&#37; in grade 2&#44; 32&#37; in grade 3&#41;&#46; However&#44; these authors did not define hypotension or hypoxia&#44; and did not analyze these complications separately&#46; Martin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> showed that CL grades 3 and 4 were independent predictors of complications during emergency intubations&#44; but they also did not analyze these complications separately&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Many authors are concerned about the high incidence of difficult intubation and complications during TI in CCUs&#46; It is very important to identify patients that are likely to present a difficult airway by using scales such as MACOCHA&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a> promoting the use of pre-intubation checklists&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> or drawing up TI guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a> Several studies have attempted to determine whether the use of video laryngoscopes in CCUs could improve glottic view&#44; thus optimizing intubation conditions and decreasing the associated complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">33&#8211;36</span></a> The role of these devices in the CCU has yet to be fully clarified&#44; and their routine use is not currently recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">35&#44;36</span></a> According to recent guidelines on intubation in intensive care<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a> video laryngoscopes should be available during TI in CCUs&#44; and should be an option during intubation&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Our study has several limitations&#46; First&#44; it was performed in the CCU of the University Hospital of Santiago de Compostela&#46; Caution should be observed when extrapolating the results obtained in a single centre to other centres with different working protocols&#46; A similar multicentre study could validate these results&#46; Secondly&#44; all TIs were performed by either anaesthesiologists or residents with at least 2 years of experience in anaesthesia&#44; always supervised by specialist&#46; Our results might have differed if TIs were not performed by anaesthesiologists or were performed by clinicians with no experience in difficult airway management&#46; Third&#44; this was an observational study&#46; Both complications and variables related to intubation difficulty were recorded by anaesthesiologists&#44; and we cannot completely rule out the possibility of data collection errors&#46; Fourth&#44; the only complications collected were hypotension&#44; hypoxia and accidental oesophageal intubation&#46; The collection of a greater number of complications could have improved the quality of the study&#46; Despite these limitations&#44; we believe that this study contributes important information on airway management in the CCU&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall">In this study&#44; we have shown that the modified CL scale is effective in determining the difficulty of direct laryngoscopy during TI and the risk of difficult intubation&#46; We show that the greater the modified CL grade&#44; the greater the difficulty in performing TI&#46; The incidence of hypoxia correlated directly with a greater modified CL grade&#44; but we found no correlation between hypotension and the modified CL scale&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tracheal intubation in the intensive care unit is associated with a high incidence of difficult intubation and complications&#46; This may be due to a poor view of the glottis during direct laryngoscopy&#46; The aim of this study is to determine if there is a relationship between laryngoscopy view using the modified Cormack-Lehane scale with the incidence of difficult intubation and complications&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">All patients who were subjected to tracheal intubated with direct laryngoscopy in the intensive care unit over a 45-month period were included in the study&#46; In all patients&#44; an evaluation was made of the laryngoscopy view using the modified Cormack-Lehane scale&#44; as well as the technical difficulty &#40;number of intubations at first attempt&#44; operator-reported difficulty&#44; need for a Frova introducer&#41;&#44; and the incidence of complications &#40;hypotension&#44; hypoxia&#44; oesophageal intubation&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 360 patients were included&#46; When the grade of the modified Cormack-Lehane scale was increased from 1 to 4&#44; the incidence of first success rate intubation decreased &#40;1&#58; 97&#37;&#44; 2a&#58; 94&#37;&#44; 2b&#58; 80&#37;&#44; 3&#58; 60&#37;&#44; 4&#58; 0&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; the incidence of moderate and severe difficulty intubation increased &#40;1&#58; 2&#37;&#44; 2a&#58; 4&#37;&#44; 2b&#58; 36&#37;&#44; 3&#58; 77&#37;&#44; 4&#58; 100&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#46;&#41;&#44; as well as the need for a Frova guide &#40;1&#58; 7&#37;&#44; 2a&#58; 8&#37;&#44; 2b&#58; 45&#37;&#44; 3&#58; 60&#37;&#44; 4&#58; 100&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; When the grade of the modified Cormack-Lehane scale increased from 1 to 4&#44; the incidence of hypoxia &#60;90&#37; increased &#40;1&#58; 20&#37;&#44; 2a&#58; 20&#37;&#44; 2b&#58; 28&#37;&#44; 3&#58; 47&#37;&#44; 4&#58; 100&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0073&#41;&#44; as well as hypoxia &#60;80&#37; &#40;1&#58; 11&#37;&#44; 2a&#58; 10&#37;&#44; 2b&#58; 12&#37;&#44; 3&#58; 27&#37;&#44; 4&#58; 100&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;00398&#41;&#46; No relationship was observed between the incidence of hypotension and the grade of the modified Cormack-Lehane scale &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>ns&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">During tracheal intubation in the intensive care unit a close relationship was found between a poor laryngoscopy view using the modified Cormack-Lehane scale and a higher difficulty technique of intubation&#46; A relationship was found between the incidence of hypoxia with a higher grade in the modified Cormack-Lehane scale&#46; No relationship was found between hypotension and the modified Cormack-Lehane scale&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objectives"
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          1 => array:2 [
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            "titulo" => "Methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La intubaci&#243;n orotraqueal en las unidades de cuidados cr&#237;ticos est&#225; asociada a una frecuencia alta de dificultad y complicaciones&#46; Una mala visi&#243;n gl&#243;tica durante la laringoscopia directa podr&#237;a ser la causa&#46; El objetivo de este estudio es evaluar si existe una relaci&#243;n entre la visi&#243;n laringosc&#243;pica valorada por la escala modificada de Cormack-Lehane y la dificultad de intubaci&#243;n y la aparici&#243;n de complicaciones&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron todos los pacientes intubados con laringoscopia directa en la Unidad de Cuidados Cr&#237;ticos durante un periodo de 45 meses&#46; En todos los pacientes se valor&#243; la visi&#243;n gl&#243;tica medida con la escala modificada de Cormack-Lehane&#44; la dificultad de intubaci&#243;n &#40;intubaci&#243;n al primer intento&#44; dificultad valorada por el anestesi&#243;logo&#44; uso de la gu&#237;a de Frova&#41; y la aparici&#243;n de complicaciones &#40;hipotensi&#243;n&#44; hipoxia&#44; intubaci&#243;n esof&#225;gica&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 360 pacientes&#46; A medida que aument&#243; el grado en la escala modificada de Cormack-Lehane&#44; disminuy&#243; la incidencia de intubaci&#243;n orotraqueal al primer intento &#40;1&#58; 97&#37;&#44; 2a&#58; 94&#37;&#44; 2b&#58; 80&#37;&#44; 3&#58; 60&#37;&#44; 4&#58; 0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; aument&#243; la incidencia de intubaci&#243;n con dificultad moderada o severa &#40;1&#58; 2&#37;&#44; 2a&#58; 4&#37;&#44; 2b&#58; 36&#37;&#44; 3&#58; 77&#37;&#44; 4&#58; 100&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; as&#237; como la necesidad de uso de Frova &#40;1&#58; 7&#37;&#44; 2a&#58; 8&#37;&#44; 2b&#58; 45&#37;&#44; 3&#58; 60&#37;&#44; 4&#58; 100&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; A medida que aument&#243; el grado en la escala modificada de Cormack-Lehane&#44; aument&#243; la aparici&#243;n de hipoxia &#60;90&#37; &#40;1&#58; 20&#37;&#44; 2a&#58; 20&#37;&#44; 2b&#58; 28&#37;&#44; 3&#58; 47&#37;&#44; 4&#58; 100&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0073&#41; y la hipoxia &#60;80&#37; &#40;1&#58; 11&#37;&#44; 2a&#58; 10&#37;&#44; 2b&#58; 12&#37;&#44; 3&#58; 27&#37;&#44; 4&#58; 100&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;00398&#41;&#46; No encontramos relaci&#243;n entre la aparici&#243;n de hipotensi&#243;n y el grado en la escala modificada de Cormack-Lehane &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>ns&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Durante la intubaci&#243;n orotraqueal en la Unidad de Cuidados Cr&#237;ticos hemos encontrado una estrecha relaci&#243;n entre una mala visi&#243;n gl&#243;tica valorada por la escala modificada de Cormack-Lehane y una mayor dificultad de la t&#233;cnica&#46; La incidencia de hipoxia se relaciona directamente con un mayor grado en la escala modificada de Cormack-Lehane&#46; No hemos encontrado ninguna relaci&#243;n entre la hipotensi&#243;n y la escala modificada de Cormack-Lehane&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivos"
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          1 => array:2 [
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Taboada M&#44; Soto-Jove R&#44; Mir&#243;n P&#44; Mart&#237;nez S&#44; Rey R&#44; Ferreiroa E&#44; et al&#46; Evaluaci&#243;n de la escala modificada de Cormack-Lehane para visi&#243;n laringosc&#243;pica durante la intubaci&#243;n orotraqueal en una unidad de cuidados cr&#237;ticos&#46; Estudio prospectivo observacional&#46; Rev Esp Anestesiol Reanim&#46; 2019&#59;66&#58;250&#8211;258&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Percentage of patients with StO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90&#37;&#44; StO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>90&#37; or &#8805;80&#37;&#44; StO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>80&#37; during tracheal intubation &#40;TI&#41;&#44; according to the modified Cormack-Lehane &#40;CL&#41; scale&#46; TI correlated with a greater incidence of hypoxia StO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>90&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;00773&#41; and hypoxia SpO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>80&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;00398&#41; as the CL grade increased&#46;</p>"
        ]
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        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Percentage of patients with systolic arterial pressure &#40;SAP&#41;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mmHg&#44; SAP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mmHg or &#8805;L65<span class="elsevierStyleHsp" style=""></span>mmHg&#44; SAP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>mmHg during intubation &#40;TI&#41;&#44; according to the modified Cormack-Lehane &#40;CL&#41; scale&#46; The modified CL scale did not correlate with hypotension<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mmHg &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;16&#41; or hypotension<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#60;</span><span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>mmHg &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>047&#41;&#46;</p>"
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      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; NIMV&#58; non-invasive mechanical ventilation&#59; SD&#58; standard deviation&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Data shown as number of patients &#40;&#37;&#41; or mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>360&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Demographics</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Women</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">106 &#40;30&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Weight &#40;kg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Height &#40;cm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">165<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BMI</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">30</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97 &#40;26&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Reason for admission to the CCU</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Postoperative surgery</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">117 &#40;32&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Respiratory failure</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">105 &#40;29&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Haemodynamic instability</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neurological instability</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;10&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Others</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;17&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Indication for tracheal intubation</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Respiratory failure</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">277 &#40;76&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Haemodynamic instability</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;17&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neurological instability</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Self extubaci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Extubation failure</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Scheduled</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Use of NIMV prior to intubation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">191 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Type of intubation</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Semielective</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">112 &#40;31&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Emergency</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">223 &#40;61&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Urgent</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Medications used for tracheal intubation</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hypnotics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">353 &#40;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Propofol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">275 &#40;77&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Etomidate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72 &#40;20&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Midazolam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Muscle relaxants</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">350 &#40;97&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Succinylcholine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">310 &#40;88&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Rocuronium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Cisatracurium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Patient demographics and aspects related to patients intubated during the study period&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Number of intubation attempts</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>One attempt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">323&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Two attempts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Three attempts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Intubation difficulty perceived by the anaesthesiologist</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No difficulty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Slightly difficult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderately difficult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Extremely difficult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Modified Cormack-Lehane scale</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 2b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Use of Frova for intubation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; NIMV&#58; non-invasive mechanical ventilation&#59; TI&#58; tracheal intubation&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Data shown as number &#40;percentage&#41; or mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-1 200 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2a 50 &#40;13&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2b 78 &#40;21&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-3 30 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-4 2 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight &#40;kg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">165<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">165<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">165<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">165<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">159<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#40;kg&#47;m<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">2</span></a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency or urgent TI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">142 &#40;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;57&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;83&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Use of NIMV prior to intubation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90 &#40;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;52&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;63&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intubated by&#58; specialist&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-1 200 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2a 50 &#40;13&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2b 78 &#40;21&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-3 30 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-4 2 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Number of intubation attempts</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>One attempt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">195 &#40;97&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63 &#40;79&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Two attempts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;19&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;26&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Three attempts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Intubation difficulty</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No difficulty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164 &#40;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Slightly difficult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;56&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderately difficult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;34&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Extremely difficult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Use of Frova for intubation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;44&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;56&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Correlation between number of intubation attempts&#44; intubation difficulty perceived by the anaesthesiologist&#44; and use of a Frova and the modified Cormack-Lehane scale determined during direct laryngoscopy&#46;</p>"
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        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at5"
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          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Data shown as number &#40;percentage&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46; patients 360&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild hypotension &#40;&#60;80<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe hypotension &#40;&#60;65<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild hypoxia &#40;&#60;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe hypoxia &#40;&#60;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Accidental oesophageal intubation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Complications during tracheal intubation in the CCU during the study period&#46;</p>"
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            "detalle" => "Table "
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-1 200 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2a 50 &#40;13&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-2b 78 &#40;21&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-3 30 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CL-4 2 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild hypotension &#40;&#60;80<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;25&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00773&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe hypoxia &#40;&#60;80&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Correlation between complications during tracheal intubation and the modified Cormack-Lehane scale determined during direct laryngoscopy&#46;</p>"
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